the thoughts of a surgeon in the notorious province of mpumalanga, south africa. comments on the private and state sector. but mostly my personal journey through surgery.

Thursday, December 02, 2010

pink and purple

recently i discovered the blog of a good friend. only problem is that he is a pathologist. i understand nothing of it, just like in the old days.

in the old days when i was still a registrar we had a joint meeting with the pathologists once every three months. if you ask me it was way too much. you see surgeons and pathologists are poles apart. for one thing, they are quite clever. for another their patients are all stable so there is never any urgency with them. i've heard they have to deal with bleeding a lot less too. but i suppose the clever bit got to me the most.

the way the meeting went was based on patient presentations. we would get a list of the cases they wanted to discuss. the surgeon involved in the case would then be required to present the case in front of everyone. he would talk about the clinical presentation, the findings an then the operation. it would usually end in a description of some or other thing that was cut out and sent to the pathologists. we would then hand over to them. i remember how their eyes would light up when we got to the bit about the thing we'd cut out. you see when they were handed the whatever it was we had removed or excised they got to work turning it into shades of pink and purple.

no matter what it was we presented them with, they would cut it into fine strips, put it on slides, colour it different shades of pink and purple and get very excited. at these meetings they would show us these slides. the thrill of it could often be detected in their voices as they spoke and could always be seen on their faces. they would wax lyrical as they increased the magnification, showing us the pink and purple ever closer. we would look, probably with visible expressions of increasing bewilderment with each new magnification, and nod knowingly. it probably didn't fool them. but the thing that irritated me the most was their standard opening line before they interpreted these pink and purple patterns to the room full of either excited or bewildered nodding faces. they always said the same thing. i think they might have been taunting us.

9 comments:

When I was a student I spent time with a pathologist. He informed me how important it was that when I send off a specimen from the OR, I be sure to inform them all possible suspected disease. This so that they don't go thru a case neglecting to search for malignacy (if that was what the team suspected) as was recently done with a uterus.

You know what they say...Surgeons know nothing and do everythingPhysicians know everything and do nothingDermatologists know nothing but give you steroids anywayPathologists know what killed you and how to cure it...just a day too late

I wasn't very good at the pink & purple stuff either. My pals & I had visual mnemonics for most of the path slides that we knew would be kept for exams, stuff like: 'that one looks like Australia,' 'that's the one with the diagonal crack in the slide,' etc.Give me shades of grey anyday.

Hmmm. I guess you need to do one or two weeks of a pathology rotation to truly appreciate what it is we do. You should try it . Please tell me you know what I'm saying when I say something is 'invading into the lamina propria?'

Two comments: 1) Path had a projection microscope powered by anarc lite; leaving the lens more than 5-10 seconds at any spot on the slide resulted in spotbleaching of the color and furtherexposure would carbonize the specimen (early '70s)2) As a student I watched the seniorresident open a lady with ascites. There were white spots on everything in sight when the fluid was suctioned out. Multiple bx were subsequently "negative". Path took pity and with heroic efforts found adenoca foci in massivescar tissue. Resident got thoroly roasted in M&M conference for inadequate biopsy specimens.

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the aim of this blog is to give insight into the mind of a particular surgeon, me. although every story is loosely based on fact, patients have been changed suitably to protect their identity. the opinions expressed are mine alone and are not meant to be considered medical advice or the opinion of any institution.